The Kids’ Doctor: Child’s unusual rash linked to muscle inflammation

One of the benefits of practicing in a large group is that you have a lot of “brains to pick” when a patient presents with an unusual case or confusing illness. This happened when one of my partners saw a child with an unusual rash. The little girl had the rash on her hands for a couple of weeks, and it was getting worse.

When the mother first brought in the child, one doctor examined the girl and said, “I think this is a rash that’s usually seen with an illness called dermatomyositis, but let me grab a few of the other doctors to look, too.”

We all agreed that this diagnosis was most likely correct, then we each threw out a little bit of our information from our own “memory bank” about the disease.

Dermatomyositis is a muscle disease characterized by inflammation and a skin rash. (Polymyositis is a similar condition, but the symptoms occur without a rash.) The cause of dermatomyositis is unknown, but it is an automimmune disease. In other words, the immune system, for some unknown reason, causes the inflammation of the muscles.

Some experts think the problem may be brought on by a viral infection, and there are studies under way to try to determine the etiology of the disease.

Like many diseases, dermatomyositis seems to occur in certain age groups. It’s most commonly seen in children between the ages of 5 and 15, but may also present in adults from ages 40 to 60. It’s more common in females.

The most common symptom is a skin rash overlying the knuckles. There may also be a purplish rash on the upper eyelids. There’s also muscle stiffness and soreness. The muscle weakness may appear suddenly or develop slowly over weeks to months. Children may complain of difficulty raising their arms over heads, or getting up from a sitting position.

In this case, the patient was referred to a pediatric rheumatologist for further evaluation and treatment.